PACS:
1. n. (acronym)Picture Archiving and Communications System. A device or group of devices and associated network components designed to store and retrieve medical images.
2. n. (acronym)Pain And Constant Suffering.

Monday, September 10, 2012

Dear Merge Clients,I am writing to make you aware of a recent press release that Merge issued last week. This release indicated that we have hired Allen & Co., a premier financial advisor, to evaluate our strategic options.

As a result of this communication, many of you have come to us with questions. I want to take this opportunity to clarify three critical points that are important for our clients to know:

Merge solutions and product roadmaps are safe. Merge offers industry leading products, delivered by a dedicated and talented workforce, with tremendous market share that will continue to live on and thrive under any ownership model.

Merge is and will continue to be a productive leader in healthcare IT. This action is a positive one. We are a cutting-edge, multi-hundred million dollar company that continually evaluates opportunities to improve our business.

Merge is not for sale. As a publicly traded company, we have a fiduciary dutyto our shareholders; to investigate all opportunities in their best interests.

While there are no assurances that the engagement of financial advisors will result in a transaction of any sort, we want you to understand that this press release is a positive one for Merge. We are investigating all of our options to ensure a healthy, long-term business for our clients, our greatest assets.Again, thank you for your continued dedication and support.

Regards,
Jeff SurgesChief Executive OfficerMerge Healthcare

I am certainly hoping that Merge is NOT for sale, especially given my discussions with Merge Brass over the years, and MOST especially given the short list of possible suitors. It was a logical conclusion to which to jump based on the prior e-mail and press-release telling us that Merge's

. . . Board of Directors has retained Allen & Company LLC, a New York-based investment bank, to assist in exploring and evaluating a broad range of strategic alternatives, including, but not limited to, a sale of the Company or a business combination.

Of course, AMICAS wasn't for sale, either. Sigh.

ADDENDUM:

I just received a call from a member of the Merge Brass. I am reassured that the actions are simply proper financial due dilligence, and Merge is indeed NOT for sale. Case closed. For now, anyway.

ON the viewing/clinical side we have the radiology technologists who generally acquire the images, while working in conjunction with the radiologists who subsequently interpret them.

On the Archiving/Storage side of the equation, we have the IT/Computer/Technical folks who do their part to make the miracles of filmless viewing, virtual colonoscopies and 3D reconstruction a reality.

Both sides of the house need each other and both sides often drive each other crazy while attempting to pull off the seemingly impossible.

It should be noted however, that while it is common for individuals to transition from the clinical side of the house to the more technical, storage side, it is extremely rare for anyone innately technical, to make the clinical transition.

This speaks to the personality types involved, as well as the theory that data centers are probably similar in construction to The Hotel California…

Here we go with our story:

Once upon a time, there was a PACS. This PACS was one of the finest in the entire kingdom. Radiologists and technologists alike, spoke of it in hushed, reverent tones. They were enchanted by its ability to enable physicians and healthcare professionals to manage, access and visualize multi-specialty medical content across the enterprise usingadvanced visualization tools, clinical content management andclinical workflowthrough a dynamic user interface.

As wonderful as this particular PACS was, it was also well established throughout the kingdom that the epoch of implementation, as it was referred to, was, at times, fraught with obstacles. Many of these obstacles had nothing to do with the beauty and efficiency of the system. Nay, it was often puzzling to the many Knights of the Implementation Council that the very radiologists who wanted and needed the system, were oftentimes, themselves the source of the conflict. Many roundtable discussions were held in order to solve this mystery of conflict and customer dissatisfaction.

During these Roundtable discussions, legends and tales from Implementations throughout the land were shared in order that they might consult with one another to decipher the lessons contained within, such that quality solutions to problems could be revealed.

It was once upon a particularly illustrious Roundtable discussion, that the tale of the Mouse and the Keyboard was first told:

Legend has it, that it was during a session whereupon one of the Knights of the Implementation Council was bestowing upon a radiologist the wisdom and understanding of the PACS, that one particularly startling incident occurred.

The PACS configuration contained 4, Grayscale, Resolution of the Highest Monitors, of the House of Siemens, in combination with a Color Monitor, descended from the Lordship of the House known as Dell. It was this Dell, whereupon the exam list was displayed and the private healthcare information of the subjects’ of the PACS was made known.

The cursor, which was the onscreen representation of the relative location of the mouse upon the desktop, had to travel vast distances across the 5 monitor expanse.

The critical moment of this story occurred when the radiologist, who had been disregarding the amount of desktop space necessary for mouse movement, caused a collision of the Mouse, upon the Keyboard.The cursor, which he desired to situate upon the patient list,was trapped upon the landscape of monitor number 4.No further leftward movement was possible due to the keyboard’s impedance upon the mouse’s leftward most pathway.

Observers gaped in amazement at the transgression, yea, many fled the room, in fear of witnessing what horrors might befall the ensnared cursor.

The radiologist registered a customer dissatisfaction issue with the Knight of the Implementation Council that such behavior was an unacceptable feature of the PACS, and that it would need to be corrected by the Knights of the Engineering Council before he would ever again lay his hands upon the PACS.

Silence fell upon the darkened room.

All eyes were upon the Knight of the Implementation Council, whereupon, she most bravely and fortuitously reached towards the keyboard, with utter disregard for her own personal safety, slid it forward, in such a manner, as to disrupt the keyboard’s negative interference upon the Pathway of the Mouse. This swift action created more usable surface area, whereupon,the Mouse and the Cursor were then both easily returned to the first monitor, that of Dell.

The radiologist nodded in satisfaction and the Project Manager, He of the Highest Order, confirmed that the solution was one of both quality and genius.

The PACS was saved and the Dominion of the PACS Company prospered ever after. (Until such time as it was sold and the name was changed)

There are many notable and almost seemingly comical stories and fairy tales in the world of PACS Implementation. The above story, while thematically framed, recalls an actual incident and challenge in the field.

All fairy tales have something to teach us. The mouse and the keyboard were functioning properly; there was nothing wrong with the application. The doctor merely ran out of mouse manipulation room and did not know that he could simply pick the mouse up, move it several inches to the right, and recover his cursor.

To those of us familiar with computers, this seems like such a simple and intuitive thing to do. It was not intuitive for this doctor. Covering for his embarrassment, he lashed out at everyone in the room and declared the system a failure. Immediate intervention was required, in order to convert a potentially sales killing, customer experience, to a more positive encounter.

The lessons in this, and the challenge to all of us, is to be prepared to take a creative approach, in order to be able to train people to utilize any system, regardless of the current level of computer literacy in which we find them.

There have been times when I have had to start from the beginning and teach a radiologist how to point and click with a mouse. I would start them off with solitaire and work my way back to the medical applications.

Conversely, many radiologists are very skilled and comfortable with computers and have presented me with different sorts of challenges. Hyper-light speed mouse clicks, borne of impatience and the need for rapid throughput, can create unwanted situations and give the appearance of poor system performance as well.

“Semper Gumby”- Always Flexible has been my guiding philosophy in this arena.

While I maintain a general lesson plan that I like to follow in order to ensure thoroughness, oftentimes the needs of the radiologist will dictate that the script needs to be abandoned, and spontaneity becomes the order of the day.The less we, as trainers, regard this not as a threat, but more as an opportunity to shine, the greater the likelihood of high, customer satisfaction, regardless of industry.

CHICAGO, Sept. 6, 2012 (GLOBE NEWSWIRE) -- Merge Healthcare Incorporated (Nasdaq:MRGE) ("Merge" or the "Company"), a leading provider of clinical systems and innovations that seek to transform healthcare, today announced that its Board of Directors has retained Allen & Company LLC, a New York-based investment bank, to assist in exploring and evaluating a broad range of strategic alternatives, including, but not limited to, a sale of the Company or a business combination.

The Company does not have a defined timeline for the strategic review, and there can be no assurance that the review will result in any specific action or transaction. The Company does not intend to comment further regarding the evaluation of strategic alternatives, unless a definitive agreement for a specific transaction is entered into, the process is concluded, or it otherwise deems further disclosure is appropriate or required.

OK...

So we are shopping Merge around, are we? What hath God (or Michael Ferro) wrought?

My friend the Once One and only PACSMan, Mike Cannavo, has been saying since Day One of the Merge buyout of AMICAS that this would happen. His prediction...Cerner will be the big winner. This makes sense, as Cerner's PACS has a reputation I wouldn't want for my worst enemy, and as a user of their EMR, I can tell you that isn't a whole lot better. If I were the brass in Kansas City, I would certainly take a page out of GE's playbook and buy a ready-made replacement for my rather, ummmmm, unappreciated product-line.

On the other hand, CEO Jeff Surges' old haunt, Allscripts, might want a piece of this, too. You never know.

Of course, it is completely possible that Merge is simply weighing its options and will just continue to to what its doing. We'll see.

The developer of enterprise imaging and interoperability technologies delved further into the imaging informatics space in April 2010 with the acquisition of PACS giant Amicas. Following that merger, Merge posted a net loss of nearly $31 million in 2010, which the company partly attributed to the acquisition costs.

Despite posting continued sales growth, the company reported a net loss of $10 million for the fiscal year of 2011 and a net loss of $5.9 million in second quarter 2012.

Things were looking up, I thought...

And a prescient note from "Sadie" on HISTALK:

From Sadie: “Re: Merge Healthcare. Three weeks after an RIF in France and one week after a 56-person RIF in the US, Merge announces plans to sell the company. I hate to say that I called this months ago.”

Blogger has been notified, according to the terms of the Digital Millennium Copyright Act (DMCA), that certain content in your blog is alleged to infringe upon the copyrights of others. As a result, we have reset the post(s) to \"draft\" status. (If we did not do so, we would be subject to a claim of copyright infringement, regardless of its merits. The URL(s) of the allegedly infringing post(s) may be found at the end of this message.) This means your post - and any images, links or other content - is not gone. You may edit the post to remove the offending content and republish, at which point the post in question will be visible to your readers again.

The notice that we received, with any personally identifying information removed, will be posted online by a service called Chilling Effects at http://www.chillingeffects.org. We do this in accordance with the Digital Millennium Copyright Act (DMCA). You can search for the DMCA notice associated with the removal of your content by going to the Chilling Effects search page at http://www.chillingeffects.org/search.cgi, and entering in the URL of the blog post that was removed.

If it is brought to our attention that you have republished the post without removing the content/link in question, then we will delete your post and count it as a violation on your account. Repeated violations to our Terms of Service may result in further remedial action taken against your Blogger account including deleting your blog and/or terminating your account. DMCA notices concerning content on your blog may also result in action taken against any associated AdSense accounts. If you have legal questions about this notification, you should retain your own legal counsel.

Now, I was a bit stunned at this. The text of the post, "Dr. Hunter's PACS" was all my own creation (obviously). I may have been a bit sloppy in crediting photos, but I tried to do so fairly consistently.

My repeated attempts to find the full text of the violation were thwarted by the rather slow and overworked chillingeffects.org website. An email to the organizers finally yielded the link to the offense:

Sworn Statements
I have a good faith belief that use of the copyrighted materials described above as allegedly infringing is not authorized by the copyright owner, its agent, or the law. [checked]

I swear, under penalty of perjury, that the information in the notification is accurate and that I am the copyright owner or am authorized to act on behalf of the owner of an exclusive right that is allegedly infringed. [checked]

Signed on this date of:
2012-8-15

Signature
[Private]

For those of you who have seen the post, and it got a lot of hits due to the presence of the word "hunter" in the title, the opening photo pictured a fellow in orange hunting gear presumably taking aim at Bambi or some other edible creature. In fact, should you Google "utah-hunting.jpg", you will see this same photo at least a dozen times, with only one of those on the website of the claimed copyright owner, Destination360.com, and none of the remainder have been prosecuted as near as I can tell. I guess the owners aren't quite as facile with Google as I am. Even so, D360 is very possessive of its photos. A further search of chillingeffects.org revealed almost 300 DMCA complaints filed by this company or its representatives.

How did Google/Blogger get involved? ChillingEffects explains:

Question: Why does a web host or blogging service provider get DMCA takedown notices?

Answer: Many copyright claimants are making complaints under the Digital Millennium Copyright Act, Section 512(c)m a safe-harbor for hosts of "Information Residing on Systems or Networks At Direction of Users." This safe harbors give providers immunity from liability for users' possible copyright infringement -- if they "expeditiously" remove material when they get complaints. Whether or not the provider would have been liable for infringement by materials its users post, the provider can avoid the possibility of a lawsuit for money damages by following the DMCA's takedown procedure when it gets a complaint. The person whose information was removed can file a counter-notification if he or she believes the complaint was erroneous.

Basically, Google evades litigation by taking down my "offending" post. I get that.

Destination360.com is certainly entitled to its rights. I do apologize for using the photo without explicit permission, and it has been removed. A lawsuit is the last thing I need. However, I DID credit the photo to their site, and by their rather draconian behavior, they have lost the chance for dozens of additional hits per day. In looking through their website (I won't link to it but you can get there if you wish), they provide reasonably good travel information for free. Revenue APPEARS to derive from hotel reservations which are powered by Rezserver.com, a division of Priceline.com. Googling reveals numerous complaints about the service, although not necessarily Destination360 itself. Caveat Emptor, as usual. Again, why (and rather high-handedly) eliminate the chance for additional hits to your only visible means of revenue?

It's way beyond the scope of this post to dissect the DMCA. But in brief, from the WiKi:

OK, OK. I get it. I suppose I would be upset if someone borrowed content from my blog without credit (WHY anyone would want to take the blame for my drivel I can't imagine...) Still, the threat of lawsuit for something as trivial as linking WITH CREDIT to someone's photo, even though there is really only additional revenue TO THE SOURCE that could result from this, is a little ridiculous. I suppose copying (uncredited) all the photos in one section of D360's travelogue, and trying to sell my expertise as a travel-agent based on this portfolio could potentially yield damage to D360, but frankly, that's a stretch.

And by the way, some of the travel information on D360's site can be found verbatim elsewhere. Who stole from whom? Simply declaring a copyright on the page does not automatically shift my content to your ownership. For example, Google this phrase about Venice:

"The muggy summer air cooks the canals and scrapes the paint and enamel from the city's finest pieces of art."

I get almost 900 results. So who really owns this copy? Heck if I know, but IF D360 borrowed the text without permission, well, I certainly hope they are prepared to receive a DMCA Cease and Desist notice.

While I'm not accusing D360.com in the least, the DMCA takedown has HUGE potential for abuse. From TorrentFreak.com (perhaps not the most honorable place on the 'net, but...):

The DMCA was once drafted to protect the interests of copyright holders, allowing them to take infringing content offline. Today, however, the system is systematically abused by rightsholders as an overbroad censorship tool. One third of the notices sent to Google are false, companies like Microsoft censor perfectly legal sites, and others use the DMCA to get back at competitors. [snip]

Aside from the mistakes outlined above, there’s also a darker side to DMCA abuse. Google previously revealed that 57% of all the DMCA notices they receive come from companies targeting competitors. [snip]

It’s safe to say that the DMCA is broadly abused. Thousands of automated notices with hundreds of links each are sent out on a daily basis, turning it into a broad censorship tool. Only the tip of the iceberg is visible to the public thanks to companies like Google who publish some of the notices online.

We can only wonder what’s happening behind the scenes at other sites, but it’s not going to be any better.

Just a few months ago the cyberlocker service Hotfile sued Warner Bros. for DMCA abuse. In the suit Hotfile accuses the movie studio of systematically abusing its anti-piracy tool by taking down hundreds of titles they don’t hold the copyrights to, including open source software.

Not good.

While we’re the first to admit that copyright holders need tools to protect their work from being infringed, mistakes and abuse as outlined above shouldn’t go unpunished. The DMCA was never intended to be an overbroad and automated piracy filter in the first place.

The above also illustrates why it’s dangerous to allow rightsholders to take entire websites offline, as the SOPA and PIPA bills would allow. The MPAA and RIAA have said many times that legitimate sites would never be affected, but didn’t they say exactly the same about the DMCA?

At least Google only took down the "Doctor Hunter" page...

The Internet is truly the New Frontier, and with that comes Frontier Justice. I've just had my first brush with it from a legal standpoint, and I guess I came out unscathed, and probably a little wiser for the experience. At least I don't have some larGE company chasing me.